Long-term response with the atypical reaction to nivolumab in microsatellite stability metastatic colorectal cancer: A case report

Nataliya Babyshkina; Nataliya Popova; Evgeny Grigoryev; Tatyana Dronova; Polina Gervas; Alexey Dobrodeev; Dmitry Kostromitskiy; Victor Goldberg; Sergei Afanasiev; Nadejda  Cherdyntseva

doi:10.33393/dti.2024.2637

Authors

Nataliya Babyshkina Department of Molecular Oncology and Immunology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk - Russian Federation and Siberian State Medical University, Tomsk - Russian Federation https://orcid.org/0000-0002-0562-3878
Nataliya Popova Department of Chemotherapy, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk - Russian Federation https://orcid.org/0000-0001-5294-778X
Evgeny Grigoryev Department of Diagnostic Imaging, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk - Russian Federation https://orcid.org/0000-0003-3187-3659
Tatyana Dronova Department of Molecular Oncology and Immunology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk - Russian Federation https://orcid.org/0000-0003-3009-2404
Polina Gervas Department of Molecular Oncology and Immunology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk - Russian Federation https://orcid.org/0000-0003-0051-8814
Alexey Dobrodeev Department of Abdominal Oncology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk - Russian Federation https://orcid.org/0000-0002-2748-0644
Dmitry Kostromitskiy Department of Abdominal Oncology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk - Russian Federation https://orcid.org/0000-0001-5691-2349
Victor Goldberg Department of Chemotherapy, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk - Russian Federation https://orcid.org/0000-0003-4753-5283
Sergei Afanasiev Department of Abdominal Oncology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk - Russian Federation https://orcid.org/0000-0002-4701-0375
Nadejda Cherdyntseva Department of Molecular Oncology and Immunology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk - Russian Federation https://orcid.org/0000-0003-1526-9013

DOI:

https://doi.org/10.33393/dti.2024.2637

Keywords:

Dissociated response, iRECIST, Metastatic colorectal cancer, Microsatellite stability, Nivolumab

Abstract

Immunotherapy has become an integral part of a comprehensive treatment approach to metastatic colorectal cancer (mCRC). Nivolumab (Opdivo) is a human immunoglobulin G4 monoclonal antibody that blocks the interaction between the programmed cell death 1 (PD-1) receptor and its ligands 1/2 (PD-L1/PD-L2), leading to inhibition of T-cell proliferation, cytokine secretion, and enhanced immune response. The US Food and Drug Administration (FDA) has approved this drug for use in high microsatellite instability (MSI-high)/deficiencies in mismatch repair (dMMR) advanced CRC patients. However, its efficacy is extremely limited in microsatellite stability (MSS)/mismatch repair proficient (pMMR) patients. We report a case of a 42-year-old man diagnosed with MSS/pMMR mCRC who has achieved a durable response to nivolumab after a progression under chemotherapy with antiangiogenic treatment. We observed for the first time an atypical response after 8 months of nivolumab treatment, with the regression of previous primary pulmonary lesions and the presence of new para-aortic lymph node lesions. This report demonstrates that a subset of pretreated mCRC patients with the MSS/pMMR phenotype may benefit from nivolumab and these patients need more attention.

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